Skeletal Fluorosis in India & its Relevance to the West

May 19th, 2012

Included below are recent newspaper articles detailing the impact of skeletal fluorosis in India. Of India’s 32 states, 17 have been identified as “endemic” areas for fluorosis, with an estimated 25 million people impacted, and another 66 million “at risk.”

In India, the most common cause of fluorosis in India is high-fluoride well water derived from borewells dug deep into the earth. According to field surveys, skeletal fluorosis in India occurs when the fluoride concentration in water exceeds 1 part per million (ppm), and has been found to occur in some communities with only 0.7 parts per million. To put this in perspective, water is purposefully fluoridated in the United States and other fluoridating countries at 0.7 to 1.2 ppm.

While the elevated consumption of water in warm climates such as India along with the increased incidence of malnutrition make direct comparisons of the Indian experience to the “West” difficult, it is striking to observe how narrow the margin is between the doses which cause advanced fluorosis in India and the doses that people are now regularly receiving in fluoridated communities. For example: a recent, carefully conducted study from Tibet found that a daily fluoride intake of 9 to 12 mg/day was associated with a high prevalence of advanced skeletal fluorosis. (Cao 2003). To put this figure in perspective, US health authorities have estimated that the daily dose of fluoride in fluoridated communities ranges from 1.6 to 6.6 mg/day (DHHS 1991).

Of greatest practical importance to fluoridated communities in the west, however, are not the advanced stages of fluorosis, but the early stages of fluorosis. It is this fact which makes the proximity in doses causing advanced fluorosis in the “east” (9 – 12 mg/day) to the doses ingested in the “west” (1.6 – 6.6 mg/day) particularly troubling.

For, while the advanced stages produce extreme, visibly crippling, effects on the skeleton, the earlier stages are less obvious, and extremely difficult to diagnose. Indeed, a common finding among researchers investigating fluorosis, is that the early stages are marked by symptoms (stiff and painful joints) which are frequently difficult to differentiate from various types of arthritis.

The difficulties in diagnosing the early stages of fluorosis stem from the fact that the arthritic symptoms may occurbeforedetectable bone changes are evident. As noted by Singh and colleagues, the early symptoms “may be misdiagnosed as rheumatoid or osteoarthritis. Such symptoms may be present prior to the development of definite radiological signs” (Singh 1963).

According to a review of skeletal fluorosis by Chemical & Engineering News:

“Although skeletal fluorosis has been studied intensely in other countries for more than 40 years, virtually no research has been done in the U.S. to determine how many people are afflicted with the earlier stages of the disease, particularly the preclinical stages. Because some of the clinical symptoms mimic arthritis, the first two clinical phases of skeletal fluorosis could be easily misdiagnosed… Even if a doctor is aware of the disease, the early stages are difficult to diagnose” (Hileman 1988).

NEW DELHI: With one-third of Delhi’s groundwater laced with excessive fluorides, the number of people falling prey to fluoride poisoning is increasing…

According to doctors, there are three forms of fluoride poisoning or fluorosis, the most common being dental fluorosis. The other two forms are skeletal and non-skeletal fluorosis.

Dental fluorosis causes yellow, brown or black streaks or spots on the teeth. There is no cure for dental fluorosis. “It is this physical symptom which makes people aware, whereas skeletal fluorosis can go undetected for a long time,” said Lady Hardinge Medical College’s Pravesh Mehra…

Executive director of Fluorosis Research and Rural Development Foundation, A K Susheela said a large number of patients are directed to the foundation since tests for fluoride were not part of the routine blood and urine tests conducted at government hospitals. Meanwhile, the non-skeletal fluorosis affects the soft tissues in the body and one may develop health problems in a very short interval. (Read more…)

It’s no potion but plain drinking water that disables otherwise perfectly fit residents of Baroli Aheer, a village near Agra in Uttar Pradesh.

And the cause of agony for the residents of this villages is an excessive fluoride content in the drinking water.

Every second person-children as well as adults-are suffering from deformed limbs, cataract, and premature ageing.

With the water sources drying up, only one source of water is left-a hand pump, which spews contaminated water.

“All this is due to contamination of our drinking water. Everyone is suffering. More than 40-50 people of different age groups are suffering. We have tried various treatments but nothing works,” said Rajkumari, a disabled girl.

Doctors attribute the problem to the excessive amounts of flouride, which is present in the drinking water.

“The water is the cause of all this. Fluorosis exceeds permissible limits and this is why patients of all ages are suffering and their bones are getting deformed. Some have even turned into invalids,” said D V Sharma, an orthopaedic surgeon.

Independent initiatives have confirmed that fluoride content in the water is between 3.5 and 4.5 ppm, much higher than the average level. (Read more…)

GANDHINAGAR: As the dawn breaks, Nirmalaben walks a long distance, carrying water. But it is not the arduous trek for water that has cast a shadow on her face.

She is worried about the water she is carrying home for her family members – it’s laced with fluoride, and many in Mehsana district are already suffering from fluorosis…

Past surveys suggest that the problem of fluoride content in water has been deepening. The Gujarat Ecology Commission’s draft Action Environmental Programme, prepared last year, said in 1991, just 831 villages had fluoride levels in groundwater higher than permissible limit…

In 1997, the figure reached 2,836. Now, the GWSSB survey says the number of such villages have nearly doubled to 4,341. (Read more…)

Jaipur, An alarming one fourth of the rural population in Rajasthan, India’s largest state, suffers from fluorosis, a debilitating disease that damages bones and teeth, research by a voluntary body shows. “The incidence of fluorosis, caused by an excess of fluoride compounds in drinking water, has been rising at an alarming rate in the state,” says Mahitosh Bagoria of Health Environment and Development Consortium.

“It is estimated that around 25 percent of the rural population in the state is affected,” he said…

The disease was virtually crippling the victims, Bagoria told IANS.

Villagers who consume non-potable water suffer from yellow, cracked teeth, joint pains and crippled limbs and also age rapidly. (Read more…)

CHUKRU (JHARKHAND): Every family in the tribal Adivasi belt in Daltonganj has at least one person with some physical deformity. Gastro-intestinal problems are routine here and miscarriages common. And almost all of them suffer from decaying teeth. Fluorosis has spread its tentacles in this village, claiming its first victim last year.

In the absence of proper drinking water facilities, these Oraon tribals have been forced to consume water contaminated with fluoride. According to Dr R.P. Singh of the Rajendra Institute of Medical Sciences, consuming water contaminated with fluoride for six months can cause flurosis. ‘‘The impact on the body varies with the extent of fluoride in the water and the genetic and dietary status,’’ he adds. (Read more…)

LUCKNOW : Though 17 states in the country have a sizable number of people with a high fluoride content in their blood, Uttar Pradesh ranks first in this regard. A Unicef report says that 11.77 million people in the state are supposed to be having fluoride content in their blood.

Fluoride, which till few years ago was found in the water in Unnao, Rae Bareilly and a few villages in Lucknow district, has spread to new areas. Now this harmful chemical is affecting 18 districts in the state. In spite of repeated appeals made by prominent social workers, the government has done nothing but to allow it to spread in Firozabad , Mathura , Agra , Rae Bareli, etc, says a survey conducted by a NGO. The survey team which collected water samples from more than 500 villages, has found that children born in those areas have been detected with low IQ, memory loss and several other kinds of debilitating problems. It may be recalled that spastic children are known to have high concentration of fluoride in their blood…

In the areas considered to be hit by fluoride, cases of gastro-intestinal diseases, nausea, bloated stomach, headache, infertility, weakness of muscles, etc, were found to be on the rise, says the team. These are other than the dental, skeletal and non-skeletal symptoms. Shifting of population, where fluoride content is alarmingly high, is one of the solutions, says a social worker who had been meeting officials to take measures to save precious lives. (Read more…)

“The sun is beating down hard amid the dusty hills but the six little devils cannot wait for the race to begin. Ears cocked for the final whistle, they fidget as they stand in line. And nervously, adjust their walking sticks.

The whistle goes. Six pairs of legs, grotesquely twisted out of shape, dig their sticks into the patch of green and hobble as fast as they can to the finish line.

All six are grinning: Some in shame, some in embarrassment, some with fear that they will collapse midway. Because they cannot run like other children their age — their limbs have been crippled beyond repair by fluoride poisoning.

In Kachariadih village, just four km from the administrative headquarters of Rajauli subdivisional town, the children need walking sticks and the young crutches. The overdose of fluoride in drinking water — about 8 mg per litre when the permissible limit is 1.5 — has maimed them for good.

…Twenty-five-year-old Parvati Rajlakshmi agrees. Bent double and in pain, eyes fixed on the ground, she says: “I came here three years ago from a neighbouring village but after giving birth to three children, I suffered excruciating pain in the waist and my physical features got monstrously transformed.”

Her children, two of who hover around her, also limp. Not a single member of the nearly 100 families in this village dominated by the Rajvanshis — who are Dalits — is unaffected.” (Read more…)

“…Reddy and Goud have vowed to continue their fast until the authorities start supplying potable water to 604 villages where high fluoride content in water has caused numerous problems, including bone deterioration, loss of eyesight, diabetes and retardation.

Workers of the Congress, the state’s main opposition party, have been organising protests all over Nalgonda district to express solidarity with the fasting leaders and to press for the supply of safe drinking water. Relay hunger strikes, road blockades and sit-ins have been a regular feature.

Police are having a tough time, especially in Nalgonda town where huge crowds are thronging the fasting camp. A couple of other Congress leaders have also joined the legislator and municipal chairman in their fast.” (Read more…)

“I have been to all the big hospitals in Bangalore. But even the doctors have pleaded helplessness. What do I do? I have now resigned to my fate”, says Channakrishna, who has been literally paralysed in the limbs due to fluorosis affliction.

The situation is no different in the other households of Pavagada taluk in the district. In Thimmapura village, Naganna’s four children have been immobilised by the affliction. In this village, which has about 50 households, over 30 individuals have been affected by fluorosis. As doctors say, all people in the entire taluk may become immobilised if the condition persists.

The prevalence of fluorosis has caused symptoms like joint pains, irregular growth of limbs and spinal cord, formation of lumps on the body resulting in inability to even stand up in some cases. Sixty-year-old Narasappa, who had never had any health problem since childhood, today has developed bow legs and cannot even stand up. Likewise, Manjunath (8), has lost movement in the limbs since the last one year.

The prevailing condition is such that a healthy child will develop abnormal growth in the limbs in a year’s time and the condition worsens over the years. Treatment of fluorosis, which affects the young and the old alike, has posed a daunting task of the medical fraternity.

According to a recent study undertaken in 24 villages of the taluk, about 90 per cent of the population had been affected by fluorosis. Almost all children have been affected by fluorosis of the teeth while in others, it has manifested as joint pains and deformity of the spinal cord and bones of the limbs.” (Read more…)

The silence is the first thing to hit you in the village of Jharana Khurd, 60 km from Jaipur. Then you realise why: There are no young people in the village. Every one of the 1,200 residents, no matter if they are 50, 30 or 10, looks old, with yellow, cracked teeth and pronounced limps.

Blame it on fluorosis, triggered by the flouride pumped up from the heart of the earth through the only functional tubewell. It’s the story of all the 146 villages in Phagi tehsil, dominated by labourers and small farmers, a tragedy underlined by three-and-half years of drought. The failure of rains has caused groundwater levels to drop and flouride levels to concentrate alarmingly.

But the flouride began making its presence felt long ago. Ask Ganga and Lachma, both in their 50s, both with hunches protruding almost at right angles from their bodies.

”We have been like this for the past 10 years,” they say. Even 30-year-old Sarju and Sayar have yellowed teeth, bleeding gums and swollen joints. Says Sayar, ”The aches and swells in the shoulders, hips, ankles make it difficult to get out of bed in the morning. If we squat on the floor, it’s painful standing up. And we all suffer from backaches.” Adds Sayar, ”We can barely lift matkas, or even work in the fields standing up.”

The children are no luckier. The pains in her hips and legs are so bad that Roshan, 10, for instance, would rather stay at home than go to school or play. ”Over the past three years, all the 25 tubewells have dried up one by one. Now we have just one handpump. The doctor says its water is poisonous, but we have no other source of water,” says small farmer Bhanwar Lal, 40. (Read more…)

KOLAR: Barely 70 km from the hi-tech city of Bangalore lies Kolar where more than 80 per cent of the children in the age-group of 6-14 suffer from skeletal and severe dental fluorosis. Reason: The water they consume has excess fluoride which has weakened their hands and legs. Worse, in Kolar, all villages depend on ground water for their domestic and other requirements. Epidemiological survey has revealed that over 26,000 people suffer from dental and skeletal fluorosis and more than 39,000 people are prone to it. According to World Health Organisation (WHO), fluoride level in water should be within 1.5 mg/L. But the fluoride concentration in ground water in Kolar ranges from 2.8 to 4.3 mg/L, which is far above the permissible levels, according to government officials.

Eleven-year-old Srikanta sits and stands with difficulty and cannot keep his feet firmly on the ground because he has severe joint pain. So is the case with 13-year-old Sahana at Nallacheravu village in Bagapalli taluk, who is irregular to school, because she suffers from severe joint pain and cannot walk. Sadly, she continues to drink the fluoride-affected water because the de-fluoridation tank in her village is defunct. According to doctors and water quality experts, fluoride affects the system slowly and accumulates in the joints and weakens it in the long run. “It is not like cough or fever which is momentary. It degenerates the system and the ailment cannot be cured,” said B.H. Vasudev, a quality assurance engineer who has begun an anti-fluoride campaign among children in Kolar. (Read more…)

JAGGAIAHPET (KRISHNA): People of this sleepy village have been drinking water which has a rich content of fluorine for years now. Ideally the drinking water should be free from fluorine, but the water supplied to the village contains 4.2 ppm of fluorine indicating dangerously harmful levels of flouride. Hence, almost every family in the village has one or two members suffering from arthritis. Pasupuleti Ramaiah (63), a farmer, can barely walk freely. He stopped working long ago as his limbs do not cooperate. “I suffer from body pains regularly and my legs have rendered me almost immobile,” he said on Tuesday. (Read more…)

PATNA: …A report reaching the state headquarters here suggests that 80 per cent of the villagers suffer from fluorosis. Fluorosis, which results from the intake of excess fluoride and causes thickening of bones and destruction of nerves, has struck the village in a major way as almost every family appears to have been afflicted with the disease in varying degrees. The symptoms start with a hip pain which spreads to other parts…

“This is the plight of most of the families here,” remarked Haridev Yadav while stressing that they are losing their family members at a relatively young age. (Read more…)

Hatathigad (Amreli): Sandhiben can’t sit up on the bed without an effort. She uses a rope tied to the ceiling to pull herself up and finally manages to get out of the bed with a little help from her grandson. Not many will believe that she is just 45. Fluorosis has added years to her age.

Doctors say consumption of water with perilously high levels of dissolved fluorides has caused calcification of ligaments that bind her joints. As a result, Sandhiben’s joints in the elbows, knees, ankles, wrists, knuckles and the spinal column have hardened, bent and become stiff.

In parched Liliya, Amreli district, water is drawn from such depth that it is heavily contaminated with fluorides. Water with as low as one part per million (ppm) of fluorides is considered unfit for human consumption. According to a Dutch survey, the fluoride content here is 5ppm…

“Over the years, cases of stiffened joints, extra bone formations, twisted spinal columns and spondylitis have become common among villagers of all ages. Babies are born with extra formations and children’s teeth start decaying early,” says Tomar. (Read more…)

Tragedy has struck many a family in the Bakhari village of Jharkhand’s Daltanganj district, where excess fluoride in water has left several with severe physical deformities and even paralyzed some…Two-thirds of the villagers have reportedly developed physical deformities as all the sources of drinking water in Bakhari have excess fluoride content.

Kaushalya Devi’s husband, her only son and four daughters have all fallen victim to excess fluoride. Her daughter-in-law too suffers from severe backaches.

Mangaru Ram’s wife, two sons and three daughters have also developed physical deformities. His 12-year-old son Tundnu Ram has been left completely paralyzed and his body is bent out of shape. (Read more… )

GUWAHATI: Thousands of villagers have been affected, many of them crippled for life, by drinking water containing excessive levels of fluoride, in some parts of Assam’s Karbi Anglong district, a report said…

Paul said the slow poisoning caused by contaminated groundwater was spreading in remote parts of the state. Many people have been suffering from severe anaemia, stiff joints, painful and restricted movement, mottled teeth and kidney failure leading to premature death while many have been crippled for life.

Fluorosis is a non-curable disease and fluoride a deadly chemical. So far, scientists claimed that the north-eastern region was safe from fluoride. (Read more…)

High percentage of fluoride in water has wrought havoc in a cluster of villages in Unnao district, says a report prepared by the Jal Nigam.

The report quotes WHO specifications which place the permissible limit at only 1 mg per litre. In these villages, however, the presence is as high as 7 mg at the highest level and 2.90 mg at the lowest. Steady consumption of fluoride water, says Arati Lalchandani, a city based doctor, affects both nerves and the bones and gradually makes movement and bending of limbs extremely difficult.

In fact the situation is so bad in Siraha Khera, a village 70 kilometres from here, that angry villagers initially refused to speak to this correspondent. (Read more…)

THE PUMP was installed in Shatap’s village of Hirapur, in the central state of Madhya Pradesh, during the United Nations’ International Water Decade of the 1980s. Its borehole was one of millions sunk throughout the world in a highly publicised race to provide the world’s poor with “safe” drinking water, planned and part-funded by aid agencies such as Unicef, the UN children’s fund.

The underground water was indeed mostly free of the bacteria that can infest polluted surface water. But nobody ever tested the underground water for natural chemicals, such as fluoride, even though they were known to be widely present in rocks from which the water was pumped. Madhya Pradesh itself is famous for its rich mineral deposits.

“The problem is enormous, unbelievable,” says Andezhath Susheela of the Fluorosis Research and Rural Development Foundation in Delhi…

All across Mandla, a district of a million or so people in eastern Madhya Pradesh, a steady stream of children have reported similar complaints since the late 1980s. But in this remote corner of central India, doctors had not heard of fluorosis. They instead diagnosed arthritis, polio, rickets, a genetic fault or simply a “mystery disease”. The link with water was never made. Until, that is, Tapas Chakma, a young research officer at the Regional Medical Research Centre in Jabalpur came to the village of Tilaipani in 1995 and suggested that a local girl’s strange disease might be fluorosis. (Read more…)

Meet 10-year-old Shatap, with a walk straight out of Monty Python. But this diminutive figure is not playing games as he waddles up the muddy lane, his knees locked together and his stunted and misshapen lower legs splayed wide like flippers. His gait is permanent; his bones grossly deformed by fluoride in drinking water pumped from a borehole at the bottom of the lane.

Besides Shatap, there is Kamala and her bow-legged sister Krishna, both daughters of the village head. Aged 14 but looking no more than nine, Krishna was forced to abandon schooling because her deformed limbs could no longer take her to the secondary school in a neighbouring village.

Many parents, including Krishna’s mother, suffer painful, stiff and misshapen backs and hips, and chronic gastro-enteritis. Bhaskar Raman, a local activist who brought the village’s plight to the attention of doctors, says there has been an epidemic of stillbirths and involuntary abortions – all known symptoms of fluoride poisoning.

All across Mandla, a district of a million or so people in eastern Madhya Pradesh, a steady stream of children have reported similar complaints since the late 1980s. But in this remote corner of central India, doctors hadn’t heard of fluorosis. They instead diagnosed arthritis, polio, rickets, a genetic fault or simply a “mystery disease”…

“The problem is enormous, unbelievable,’ says Andezhath Susheela of the Fluorosis Research and Rural Development Foundation in Delhi. She has been unravelling the national story for a decade during which time her estimate of the people leading “a painful and crippled life” from fluorosis has risen from one million to 25 million and now to 60 million – six million of them children – spread across tens of thousands of communities. “In some villages three quarters of the population are seriously affected.” (Read more… )

“Bartram said there were many other “silent threats,” including excessive fluoride in the water supply in China, India and the Rift Valley in Africa. In China alone, 30 million people suffer crippling skeletal fluorosis.”(Read more…)

NIGER: The children, ranging in age from 15 months to 14 years, contracted skeletal fluorosis, a disease which causes deformities of the bones, according to medical sources.

The children suffer symptoms ranging from stiffness of the joints, arthritic-like symptoms and chronic joint pain, to calcification of the vertebral column, crippling spine and joint deformities, muscle wasting, and neurological defects. Mottling of the teeth is a less serious form of the disease that comes from ingesting lower levels of fluoride (dental fluorosis).

According to Dr. Moussa Koini, who has written a medical dissertation on the topic, the disease is caused by drinking water containing too much fluoride.

Water samples taken in Tibiri from SNE facilities show that the water contains 4.77 to 6.6 milligrams per litre, instead of the maximum 1.5 milligrams recommended by the World Health Organisation (WHO). . .

Skeletal fluorosis is a very disabling disease.

Hadjia Kande, a mother whose two youngest children are paralysed, says life is a daily burden. ”Look at my children. Neither one of them can even go to the toilet by himself. I need to provide them with constant attention, so I can’t regularly get to my job at the cotton mill.”

One of the children, 13-year-old Salissou, expressed how sad he is. ”I’m afraid to drink water from any source, even well water. Look at the state I’m in, it’s really a shame,” he said.

Although it disables both boys and girls, the disease is even worse for girls as it can have grave consequences for childbearing. Dr. Koini explained that ”if there are outgrowths around the pelvic area, girls can have difficulty giving birth and may have to have Caesarian sections because of an inability to deliver vaginally,” he stated.” (Read more…)

In the last two years, more than 500 people in the four affected villages have developed serious bone disorders, which the government says is caused by excessive — but naturally occurring — fluoride in the drinking water.

“We have identified 139 children with bone fluorosis, who will undergo corrective surgery,” said Sajid Maqbool, director of the Lahore Children’s Hospital…

Absorption of extremely high levels of fluoride damages the bones, say medical experts.

“This makes them soft, crumbly and chalky white. In later stages, this causes stiffness of joints, inability to move the spine and neurological symptoms when the spinal cord is compressed by deforming bones,” said an expert from Lahore’s Institute of Public Health. (Read more…)